America’s healthcare conundrum

Health practitioners from both sides of the Atlantic met to discuss the huge challenges that Obamacare presents to the US healthcare system

20 October 2014

In May 2014 the Odgers Berndtson Global Healthcare Practice organised a roundtable event bringing together the great and the good from a US health industry experiencing fundamental change as a result of the Obamacare reforms

The intention with this significant New York event was to give notable US healthcare leaders such as Dr Jonathan Perlin, chief medical officer at the HCA, and Dr Jack Cochran, executive director of the Kaiser Permanente Foundation, a greater understanding of how the UK’s National Health Service (NHS) – the world’s largest public health system – has dealt with regular transformations and turbulence over the course of its 70-year life.

The use of the word ‘significant’ is deliberate. It is often the case that America leads the way so for the tables to be turned, and for Americans to be keen to learn from, in this case, the British experience, is a rare occurrence.

The US health sector is understandably keen to learn more about the system in operation in the UK as Obama Healthcare becomes a reality and major challenges lie ahead for that huge $150billion market.

The man chosen to be the guest speaker, and to give the British perspective, was Sir Ian Carruthers, the former chief executive of NHS South of England strategic health authority and without doubt one of the most successful and experienced chief executives the NHS has ever produced. With a career spanning 43 years in the NHS he is no stranger to big system reforms. Indeed one of Sir Ian’s first remarks was that he has been through 15 NHS restructures in his time.

Sir Ian began by outlining the main characteristics of a high-performing national health system. He identified a focus on preventative health, good quality of care and accessibility, giving good taxpayer value and being affordable.

There should also be, he stressed, integration between healthcare and social care systems to improve effectiveness of care, improve efficiencies and reduce costs. The ‘capacity and capability’ to change should also be present, as should good leadership from politicians and clinicians. Retaining public confidence in the system should also be high on the agenda because once lost it is difficult to regain.

In a rather more sobering way Sir Ian said that no global healthcare system currently had all these characteristics in place.

Specific to the UK Sir Ian identified major challenges such as an ageing and frail population, the rise in chronic diseases, mental illness and dementia, the slow adoption of innovative technology and treatments, and declining Government investment putting pressure on quality of care and staff recruitment/pay.

Sir Ian urged clinicians to do more to help find solutions to these challenges. “We won’t transform many of these situations without very clear doctor leadership,” he said. “We need to see clinicians as leaders and encourage them to be advocates for change of our system. Up until now that hasn’t been the case; whenever we have had change, interest groups and clinicians in particular have sought to block where it has served their own particular interests.”

Sir Ian added that the focus of previous NHS reforms had been dominated by politicians talking up structures and mechanisms rather than doctors ‘taking charge’ and outlining how to improve care. Without the two sides working together and providing a single voice of change, he argued, the chances of successful reform are low – something American health practitioners should take note of.

“If you haven’t got a compelling narrative to get the meaning of what you are trying to do you will never do it. I think you are struggling with this in the Obama reforms because whatever you think of the idea it is the implementation that determines success,” he said. “Quite often we have not got the alignment of what the hearts and minds of the professionals and patients are. We can never separate adequately the political from what is managerial sense and what is actually a practical reality, as all three of them need to be aligned to be successful. It is in the implementation that things go wrong and for that reason you have got to be very prepared to say that we have got this wrong and it needs changing.”

As part of the roundtable discussion that followed Sir Ian’s thought-provoking speech, HCA’s Dr Perlin highlighted his comments on the role of the narrative in facilitating transformation. Dr Perlin said that a shared narrative could help engage and align multiple constituencies from politicians to the healthcare workforce. “A shared narrative within the workforce allows management through meaning and a narrative of success is more compelling than one of failure,” he commented. “An effective narrative must address not only those who stand to gain but those who fear loss.”

The feeling around the discussion table, which included Steve Potter, managing director of Odgers Berndtson USA, Keith Gaspard, partner in Healthcare & Life Sciences in the US, and Penny Mirams, partner in healthcare for Canada, was that it was agreed with Sir Ian that the tricky equation in major system reform is how to deliver higher-quality care to more people for less money. Fundamental to solving this equation is having the right leadership in place.

Outside of China, India and one or two other emerging markets, very few countries have the luxury of being able to build a new health system from scratch. For the vast majority of those in Europe, North America and Australia, the challenge is to transform what is currently in place into more effective and commercially viable provider frameworks, and to do so in a way that keeps the voters, unions, clinicians, financiers and a myriad of other bodies happy. Healthcare is at the top of the political and public agenda and it seems to be the one area that can make or break a government.